US to end HIV funding programmes in South Africa amid strained relations

The United States has announced plans to end funding for HIV and AIDS programmes in South Africa, a move that could reshape one of the world’s largest public health responses to the epidemic in a country where more than eight million people are living with the virus.

The decision affects support that had been channelled to South Africa through the United States government’s global HIV initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR), which has been providing about $400 million annually to help fight HIV and AIDS in the country.

The funding had covered roughly a fifth of South Africa’s overall HIV response spending until 2025.

A State Department official confirmed that a “phased drawdown” of PEPFAR funding would now begin. The move was attributed to “South Africa’s failure to make demonstrable progress on policy requests by the administration”.

The official also said the intention was to “foster self-reliance” and reduce dependence on American support, adding that “South Africa is a middle-income country and is more than capable of supporting its own health programs”.

The decision follows a period of strained relations between United States and South Africa, which have worsened since the start of the administration of Donald Trump.

Early in his term, Trump issued an executive order accusing South Africa of policies that he said dismantled equal opportunities and fuelled violence “against racially disfavored landowners”.

The South African government has rejected those claims, saying its policies are aimed at addressing long-standing inequality rooted in apartheid history. The executive order also referenced South Africa’s case against Israel at the International Court of Justice and its relations with Iran.

The White House said that because of these “unjust and immoral practices”, additional aid to South Africa would not be provided.

Trump has also repeated claims of a “white genocide” in South Africa, a claim that has been widely discredited. In line with this narrative, the administration has introduced a refugee pathway for Afrikaners, descendants of early European settlers, who are now among the few groups being considered under the programme.

South Africa has pushed back strongly against these positions, maintaining that no such persecution exists and that its policies are aimed at correcting economic imbalances.

In response to the funding cut, South Africa’s health ministry said it had not received formal notice of the decision but noted that it had “long been working on a self-reliance plan”.

The ministry added that while PEPFAR support played a major role in the country’s HIV response, antiretroviral treatment programmes are funded separately, with most of the financing coming from the government.

PEPFAR support has for years been central to South Africa’s HIV strategy, helping expand testing, treatment, and prevention services in a country with the highest number of people living with HIV globally.

Efforts to repair relations between Washington and Pretoria have faced setbacks. A high-level meeting at the White House between Trump and South African President Cyril Ramaphosa ended in sharp disagreement over allegations of discrimination and foreign policy positions.

Relations were further strained when the United States boycotted the G20 summit hosted by South Africa last November, marking another sign of widening diplomatic distance between the two countries.